Bilateral Angle Closure Glaucoma In A Teenage Girl

Primary angle closure glaucoma (PACG) usually presents as unilateral and has acute onset. To the best of our knowledge, chronic PACG in very young age is rare. We share a case report of a teenage girl with advanced glaucomatous changes and, on gonioscopy, had synechia and closed angle of anterior chamber. She was treated by bilateral laser iridotomy and topical glaucoma medication. As patient had poor control of IOP on medications in right eye , she underwent filteration surgery in right eye. The author concludes that, even at very young age, in the absence of predisposing factors for secondary glaucoma, the patient should be investigated for PACG and managed accordingly

Comparison of Analgesic Effect of Fentanyl and Fentanyl with Midazolam as an Adjuvant to Intrathecal Bupivacaine in Lower Limb Surgeries

Introduction: Coadministration of drugs with synergistic effects considered one of the methods to increase the effectivenessof analgesia. The aim of this study is to evaluate the efficacy of midazolam to potentiate the analgesic effect of fentanyl as anadjuvant to bupivacaine.Materials and Methods: This is a hospital based prospective, randomized, double-blind interventional control study conductedat SMS medical college and hospitals, Jaipur. A total of 90 patients were enrolled in the study. They were allocated into threegroups, 30 in each. A total of 3.7 ml study drugs injected in each group. Intraoperative monitoring of hemodynamic parameters,duration of surgery, onset of sensory and motor block, duration of analgesia, sensory and motor block, and incidence of adverseeffects was done and compared.Results: There was no significant difference in mean pulse rate, systolic blood pressure, diastolic blood pressure, and meanarterial pressure (P > 0.05). The mean duration of surgery in Group A, B, and C was 101.3 ± 13.08, 92.93 ± 15.28, and 95.93± 16.03 min, respectively (P > 0.05). The mean onset time of sensory block in Group A was 7.29 ± 1.23, in B 4.92 ± 0.60, andin C 4.79 ± 0.91 min (P < 0.05). The mean onset time of motor block in Group A was 8.75 ± 0.55, in B 7.79 ± 0.42, and in C7.57 ± 0.29 min. In Group A, mean time of sensory block was 194.4 ± 6.80, in B 236.60 ± 12.79, and in C 254.30 ± 7.32 min. InGroup A, mean duration of motor block was 180.2 ± 5.22, in B 188.7 ± 4.04 and in C 199.6±6.69 min. In Group A, mean durationof analgesia was 215.7 ± 14.6, in B 445.8 ± 18.92, and in C 522.3 ± 16.33 min. The incidence of adverse effects was insignificant.Conclusion: We conclude that midazolam potentiates the effect of fentanyl in terms of prolonged duration of analgesia andprolonged motor and sensory block when used as an adjuvant of bupivacaine without any significant hemodynamic compromise.

Congenital cystic adenomatoid malformation associated with ipsilateral eventration of the diaphragm.

A two-month-old girl was operated for a left-sided eventration of the diaphragm. At surgery, a mass representing an extralobar pulmonary sequestration (EPS) was found inferior to the left lobe of the lung and was excised. Histopathological examination of the resected specimen showed presence of a type II congenital cystic adenomatoid malformation (CCAM) within it. A review of the relevant literature is presented.